Embryologist Dr George Koustas answers the questions you are sometimes too scared to ask

We always talk about our enormous love and respect for the incredible men and women who work in the IVF labs, so you can imagine how delighted we were when one of the amazing embryologysts, Dr George Koustas, from the Agora Fertility Clinic said “ask me anything”. 

Do you have any exciting facts about ICSI that we can share?

A licensed ICSI practitioner has undergone extensive training in micro-manipulation technique as well as reproductive biology knowledge. Only the most specialised and experienced professionals will achieve the best results. Successful fertilisation for the creation of an embryo depends on the use of a very precise and high-powered microscope to inject a single sperm into the cytoplasm of an egg and a very steady hand! It’s like a microscopically low scale precision surgery, where the surgeon makes the difference between success and failure.

Failed Fertilisation . . . Why does it happen? What do I do next? 

Going through IVF and finding out your eggs have failed to fertilise is always a very emotional and frustrating situation. This tends to happen when the sperm was unable to penetrate and/or fertilise the egg and is due to a sperm or egg problem. 

Total failed fertilisation is a rare unpredictable event that occurs in 1-5% of IVF even with normal oocytes and sperm. 

In most failed fertilisation IVF,  we would recommend ICSI to allow for the sperm to be injected directly into the egg. Our consultants will also carry out more tests to try and define the root cause and correct it.

What makes a good blastocyst? 

A blastocyst is an embryo grown in the laboratory for 5 days. At this stage the embryo has more than 200 cells. After this time the cells can’t be counted anymore and are assessed based on growth rate and presence of specific cell types. A good blastocyst has distinct inner layer of cells (which form the fetus) and clear outer cells that form the placenta. In the lab we assign quality ranking based on the grade of cells, where A is the best quality and D the lowest quality. Waiting to implant a blastocyst embryo often generates a higher pregnancy rate than day 2 or 3 cleavage stage embryos.  

How do you select the best quality embryo for embryo transfer? 

The selection process is based on morphological criteria such as cell numbers, even cells, growth rate and presence of degenerated cells. Embryos with best quality have higher chances for a pregnancy.

Is embryo glue helpful?

Embryoglue is a solution that some clinics use to keep the embryo in the dish before the embryo transfer. What makes this solution different is that it contains a substance called hyaluronan which may assist the embryo to implant in the womb. To date, the data shows that Embryoglue increases the pregnancy rates by 10%, but further good quality studies are required to confirm the efficacy. 

How does ICSI work? 

This specialist technique is often used because of low sperm count or the inability of sperm to swim towards the egg. The technique involves the use of a high power microscope to inject, with extreme precision, a single sperm into the cytoplasm of an egg. This enables successful fertilisation and creation of an embryo. During ICSI, a very fine tiny glass needle, called micropipette, selects the best sperm from a pool of many sperm cells, immobilises it and places it into the micropipette. Another pipette holds the egg stable whilst the sperm is injected slowly into the egg. The process is repeated until all eggs have been injected with a single sperm. 

We can’t thank Dr Koustas enough for his time. If you have any questions for Dr Koustas or would like to get in touch with the Agora Clinic visit here

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